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Expanding Medicaid is crucial for Louisiana residents: Editorial

Tulane Community Health Clinic

Dr. Keith Winfrey examines Harlan L. Jennings at the Tulane Community Health Clinic March 1, 2009. New Orleans area clinics have proliferated since Hurricane Katrina with the support of federal funding.
(Ted Jackson, NOLA.com | The Times-Picayune archive)

The list of experts, advocates and analysts who see the value in Louisiana expanding Medicaid under the federal Affordable Care Act is long -- and growing. The chief health officer in New Orleans and two former Louisiana health secretaries -- David Hood and Fred Cerise -- argued in the past week for the state to accept the Medicaid money. The Louisiana Hospital Association has taken the same position.

Together Louisiana, a coalition of 120 religious congregations, and AARP Louisiana rallied at the Capitol in late April imploring Gov. Bobby Jindal to change his mind about rejecting the Medicaid money.

Reports from the Kaiser Family Foundation, the nonpartisan state Legislative Fiscal Office and the governor's own Department of Health and Hospitals have detailed the ways in which Louisiana would benefit from the expansion.

Perhaps most significantly, lawmakers on the Senate Health and Welfare Committee took a stand Tuesday and voted to send a modified expansion bill to the full Senate for debate. They want Gov. Jindal to ask to use the Medicaid money for buying private health insurance for low-income residents, as Arkansas is asking to do.

Still, the governor is refusing to budge. "We continue to be opposed to Medicaid expansion. We think this would be bad for Louisiana, bad for our taxpayers, bad for our people," he said after the committee vote.

Gov. Jindal argues that over a decade Louisiana might have to spend $1.7 billion on the expansion, that Medicaid is inefficient and that there are too many uncertainties. He also says that too many Louisianians would be dependent on the government for health care under the expansion.

Frankly, none of that is persuasive.

The Legislative Fiscal Office and DHH found that the state would save money with the expansion, which would cover families with income up to 138 percent of the federal poverty level. The fiscal office's analysis shows a savings of as much as $544 million over the first five years and estimates the state would save between $185 million and $510 million over 10 years.

Under a low-impact scenario, DHH predicted Louisiana would save as much as $367.5 million over 10 years by taking the extra money. On the higher-impact end of the spectrum, the DHH report showed a cost of $1.52 billion to $1.71 billion over a decade.

The Public Affairs Research Council pointed out, though, that the higher costs to the state probably won't materialize. The increase in rates on which DHH based the estimate "is an unlikely scenario," PAR said.

Even if Louisiana were to have to spend $1.7 billion to get the $15.8 billion that would flow to the state under the expansion, it is worth the cost to provide tens of thousands of residents with health coverage.

As for the uncertainties in the expansion, Mr. Hood offered a reminder of the good that expanded Medicaid coverage has done for children here over the past 15 years. Thanks to the state's aggressive efforts to get qualified families to sign up, fewer than 4 percent of Louisiana's children now lack health insurance.

Gov. Jindal has touted the results of the Louisiana Children's Health Insurance Program. In announcing in 2008 that the state had exceeded its goals for adding children, he said: "Health care is an absolute essential for every Louisiana family - and especially our lower income and working families."

He was right about that. Regrettably, he refuses to acknowledge the benefits of the current expansion.

If he continues to reject the new Medicaid money President Obama's administration is offering, Louisiana residents will suffer the consequences.

The state estimates that 214,000 uninsured residents could get coverage under the Medicaid expansion. Without it, those Louisianians will have to seek care in the public hospital system. Hospitals aren't the most efficient way to provide care, though, and low-income residents -- particularly in rural areas -- don't have easy access to a state-funded hospital. Medicaid is the best option for providing them preventive care.

That is the argument made by New Orleans Health Commissioner Karen DeSalvo. She is worried about how to keep the primary care clinics that have blossomed in the city post-Katrina open without the Medicaid expansion. The clinics, which offer preventive care to almost 60,000 people, have been operating on a federal waiver that is set to expire. "We have to really get ourselves focused on sorting out what we're going to do in January 2014," Dr. DeSalvo told a City Council committee Thursday.

It would be a shame if the clinics were put in jeopardy. Unfortunately, that seems to be where we are headed.

The Senate Health and Welfare Committee's 4-3 vote to send a modified version of Sen. Karen Carter Peterson's Medicaid expansion bill to the full Senate was a hopeful development. But the legislation still has a lot of hurdles. For one, House Speaker Chuck Kleckley said Thursday he doesn't believe lawmakers will approve any proposal to accept the Medicaid expansion this year. He said there are too many differing numbers on the cost to the state.

That is a poor excuse. During the first three years of the expansion the federal government will pay 100 percent. The state's share would gradually increase to 10 percent in 2020 and beyond.

Meanwhile, thousands of Louisiana residents would have a chance for a healthier life. How can Gov. Jindal and lawmakers deny them that?